Though survival has dramatically improved for patients with HIV, there has been no decrease in the quantity of ICU admissions for this select patient population.
One of the most common reasons for ICU admission is now adverse effects of antiretroviral therapy (ART).
When managing a critically ill HIV patient in the ED or ICU, consider the following effects of ART as an etiology:
Lactic acidosis
Seen with nucleoside reverse transcriptase inhibitors (NRTIs): greatest risk with didanosine, stavudine, and zidovudine
Presentation: rash, fever, shortness of breath, vomiting, abdominal pain
Can rapidly progress to cardiovascular collapse
References
Tan DHS, Walmsley SL. Management of persons infected with human immunodeficiency virus requiring admission to the intensive care unit. Crit Care Clin 2013; 29:603-20.
